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07/05/2012
RESPONSES/COMMENTS (EMR)
RE: EHR Exemption for Small Practices? (Michael Brody, DPM)
From: Mark H. Sugar, DPM
I am 65 years old and in practice since 1974. After scrutinizing EMR or EHR last year for thousands of dollars, I decided that I would not participate in this program, take my lumps and bumps, and forego the meaningful use incentive payments by the government. I would like to address Dr. Brody's comments and ask what penalties will be enforced in 2016 when I may very well be out of podiatry; and also address the issue of electronic referrals (which at this time make up less than 1% of my referrals in my practice). My feeling is that I can conduct my solo practice until I retire successfully and without EHR. Am I wrong? Are there others who feel as I do?
Mark H. Sugar, DPM, Hyattsville, MD, msugar8364@aol.com
Other messages in this thread:
06/25/2025
RESPONSES/COMMENTS (EMR)
From Gary S Smith, DPM
I have had ModMed for 8 months. There is a difference between EMRs today. Some are better suited for a Corp. or big practice and some for solo or small group. I think ModMed is very good for a large practice. It creates a bill at the end of the visit and does a good job, but the attending has to review and edit. You can't just dictate if you're in a hurry because it won't generate a bill if you don't do a diagnosis and chart flow. It is time-consuming and when you are adding clicks and editing to bill appropriately, you are doing your billing person's job for them.
The biggest issue I have with it is that it does not generate a day sheet report. You have no idea if claims were edited, deleted, or cash deposits, etc. There is no AR report like with Sammy or Cerner. You have to create one yourself and it is complicated and time-consuming. It does not generate a monthly practice analysis like Cerner or Sammy either. You have to self-create reports on each parameter and once you get it, you can't print it.
Gary S Smith, DPM, Bradford, PA
06/23/2025
RESPONSES/COMMENTS (EMR)
From: Jay Callarman, DPM
The practice I work for was recently purchased by USFAS and they use ModMed for Podiatry. It is very thorough and easy to use.
Jay Callarman, DPM, Yakima, WA
06/19/2025
RESPONSES/COMMENTS (EMR)
RE: Option for Sunsetting of TrakNet
From: K.G. Gauntt, DPM
For those who may be looking into a new EHR platform, particularly with the sunsetting of Traknet coming up, one viable option to look into is Populate. I was one of the users of the above since its inception. I made the switch to Populate about a year ago when the program was relatively new and had many holes to fill; they are working diligently to do so. It is not podiatry-specific but podiatry commands the largest share of users.
Remember, we all have our own wish list for these programs and the perfect one does not exist. I looked into and demoed many and rejected most for a variety of reasons. I was looking for simplicity and integration foremost. Most of the platforms have most of the features, some are better at one thing than another, one area of weakness is another's strong point. You have to decide what fits you and remember they all make promises and demo the easy stuff.
Populate is becoming a better and better platform weekly. It is easy to transition to, easy to learn, and is rapidly adding AI based processes, not all of which I use as I simply do not need them at this time, but they are available.
Disclosure: I am not paid for this opinion.
K.G. Gauntt, DPM, Hillsborough, OR
12/05/2024
RESPONSES/COMMENTS (EMR)
From: Kenneth Meisler, DPM
I agree with Dr. Musella that you should NOT scan your paper records when switching over to an EMR system. I switched from paper charts and traditional x-ray film to an EMR program and digital x-rays about 17 years ago at the same time. At the time, I had already been in practice for more than 30 years and our office had 30-40 thousand patients we had seen and many active patients. We did NOT scan any of our charts or x-rays. We kept all of our existing charts in the office.
If a patient came, in most of the time, we did not have to pull out their old chart or x-rays. In some cases, we did have to go back to old notes or x-rays but it was not often. We kept all of the charts and x-rays for the legal period and eventually destroyed them. Any x-rays that we felt we wanted a copy of, we took a digital photograph of and stored it by the patient's chart number in a file.
Kenneth Meisler, DPM, NY, NY
12/04/2024
RESPONSES/COMMENTS (EMR)
From: David Secord, DPM
When I transitioned my office from paper, I rented a scanner and did it myself. Commercial scanners are able to do a lot of pages in a short amount of time. I converted my entire office in a weekend. Here is some data on the scanner I rented: BancTec IntelliScan XDS.
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BancTec IntelliScan XDS |
BancTec has, once again, stepped to the forefront of the marketplace with the introduction of IntelliScan, a next-generation document processing suite that redefines speed and produces superior, higher resolution images. The latest in BancTec's proven line of integrated solutions for...
Editor's note: Dr. Secord's extended-length letter can be read here.
12/03/2024
RESPONSES/COMMENTS (EMR) - PART 2
RE: Scanning Paper Records (John Moglia, DPM)
From: Al Musella, DPM
If you’re dealing with old records, I wouldn’t bother with an EMR system for them. Instead, just scan each entire chart into a single pdf file, including all reports and even billing records if necessary. Name the pdfs with a consistent format, like LastName_FirstName_DOB. For file organization: If you have fewer than 1,000 charts: Store all the files in a single root directory. If you have more than 1,000 charts: Create sub-directories for each letter of the alphabet and organize the files into folders based on the first letter of the patient’s last name.
To secure the data: Encrypt the drive using a tool like BitLocker (included with most versions of Windows except the Home edition). Backup the encryption key or password in multiple secure locations to ensure you don’t lose access. Make three copies of the data on three separate external drives. Keep one in the office for quick access. Store one in a safety deposit box for long-term backup. Keep one at home as an additional backup.
Important Notes About Storage Media: Hard Drives: Hard drives don’t last indefinitely, especially if left unused. Their lifespan is typically 3–5 years. I learned this the hard way when I tried to recover photos from a 30-year-old drive. Solution: Each year, copy one of the drives onto a new external drive. Verify that you can open and decrypt the files, then destroy the old drive. Rotate this process yearly so that each drive gets replaced every 3 years. Optical Discs (DVDs/Blu-rays): These last longer than hard drives but are harder to encrypt. Thumb Drives: Thumb drives are easier to access and encrypt, and they’re simple to destroy when no longer needed—just smash them!
Al Musella, DPM, Hewlett, NY
12/03/2024
RESPONSES/COMMENTS (EMR) - PART 1
RE: Scanning Paper Records (John Moglia, DPM)
From: Kenneth Coates, DPM
Regarding Dr. Moglia's query concerning scanning records of inactive and deceased patients, I recommend not wasting time and money scanning these records. I retired 5 years ago with paper records, and I can attest that after the first 6 months to one year you probably won't need to access them at all.
However, as you stated, you need the records kept for 7 years. This can be done by boxing the paper records in whatever order you currently have and storing them in a corner of your basement or in a rental storage unit. Don't waste a lot of time on this, you are a busy doctor and you should be working towards your future.
Kenneth Coates, DPM (retired) Cape Coral, FL
08/09/2024
RESPONSES/COMMENTS (EMR)
From: Larry Kosova, DPM
Dr. Weiss, I have been involved with speech to text and integration with EMR systems for about 25 years. I beta tested 5 AI medical charting (Ambient listening) systems. After working with the companies' programmers, I have been live in the office for over 5 months now. There are major differences between the products. I am a medical advisor for Heidi Health AI, since it was very clear to me the differences. There is a podiatry specialty. There is even a podiatry assistant and one for about 50 different specialties. They are also showing at the APMA meeting this week and are one of the sponsors of the meeting. I am at the booth. The big differences are the ability to use the product the way you want to, and be able to tailor it for your personal needs.
Many products only have 1 or 2 ways to make a note. With Heidi you can make any template or any note you want to. We use it for our back to school forms, patient summaries, referral notes, etc. It listens to me and my patient. I push a button. It creates a note in 30 seconds. It automatically creates the SOAP or H&P note. I re-read, if needed, for minor edits and done. It is so much faster than using Dragon. I haven't touched it since starting AI charting. There will be more on this in the September issue of PM magazine. Please reach out anytime.
Larry Kosova DPM, Medical Advisor - Heidihealth AI
07/17/2024
RESPONSES/COMMENTS (EMR)
From: Pete Harvey, DPM
I use MD Tool Box. My service fee is $30/month excluding controlled substance. You can contact them for a quote on the extra fee for controlled substance. I think it’s only $10-20 more. I also do not write many controlled substances. However, in Texas, the pharmacy board provides a script pad with a specific barcode on it to identify the prescriber. They provide that service as a courtesy for low prescribers.
There are six security features such as: Thermochromatic Rx ink mark, Repetitive VOID when copied, Rx must be blue, true fourdrinier watermark, paper is chemical sensitized to prevent alteration, and invisible fluorescent fibers revealed with black light. My pads are kept in a safe. You should contact your state controlled substance overseer and ask if they provide that same service.
Pete Harvey, DPM, Wichita Falls TX
07/16/2024
RESPONSES/COMMENTS (EMR)
From: Elliot Udell, DPM
We use Veradigm for all of our prescription writing. They are a branch of Allscripts.
Elliot Udell, DPM, Hicksville, NY
04/26/2024
RESPONSES/COMMENTS (EMR)
From: Lawrence Kosova, DPM
The question you are asking is an excellent one and will be answered by the end users/doctors.
Just so you know, I have beta tested 5 products in the AI scribe world and I am on the medical advisory board for HeidiHealth. This is a free AI scribe with multispecialty language models including podiatry, so you can get your SOAP and H&P notes done efficiently. All the EMR companies I have talked with, including the large players like Epic and Athena, are beta testing solutions now.
These will be profit centers for the EMR companies. So whatever product you are currently using, you should be asking what EMR companies are they currently in discussions with for integration and what are their projected timelines? I am perfectly happy right now being about 98% finished with my chart note when I walk out of the patient room. I then spend a few minutes to review the chart note and...
Editor's note: Dr. Kosova's extended-length can be read here.
03/05/2024
RESPONSES/COMMENTS (EMR) - PART 2
RE: How to Save EMR Notes
From: Daniel Chaskin, DPM
Why not save every chart note electronically as a .PDF file to protect against your EHR provider closing down? If you are computer savvy, you can program a macro to automatically perform this task.
Daniel Chaskin, DPM, Ridgewood, NY
03/05/2024
RESPONSES/COMMENTS (EMR) - PART 1
From: Jack Sasiene, DPM
I have used Nextgen for 10 years until I recently was forced to change to a hospital-based EMR. Nextgen was great for my single doctor practice. It was fully customizable at each level of charting with the ability for the user to change/create whatever was needed very easily. You could create letters to docs, merge patient data into them, and save the original template. You can create favorite tabs for diagnoses, procedures, care plans, etc. that include the CPT code modifiers, macros; and it puts it into the billing module. The eRx module allows creation of favorite meds AND multiple favorite sigs (e.g. BID) for that medicine.
These features eliminate much of the typing and clicks needed to fill the chart, but still allow for alteration. As with any system, it requires work to set it up the way you work. This takes a few months or hair pulling, But once done, it is possible to create unique charting in minutes and be done. My front office had no complaints about the billing module .We sent out all claims at the end of the day. Their clearinghouse was fine. You need to spend some time with each system and try to use it yourself. Don’t just allow them to “show how quickly you can work” in a system they have already set up.
Jack Sasiene, DPM, Texas City, TX
08/30/2023
RESPONSES/COMMENTS (EMR)
From: Brian Lee, DPM
The best solution I've found for the ongoing cost of EHRs? My biller provides the EHR at no cost to me! And it's NextGen. I've had it for almost 8 years and have been pleased.
Brian Lee, DPM, Mt. Vernon, IL
08/29/2023
RESPONSES/COMMENTS (EMR)
From: Howard E Friedman, DPM
I recommend Practice Fusion as an EHR. I have been using it for the past 10 years and can say that they continue to make it better and better. Practice Fusion is cloud-based, cost-effective, and comprehensive. It includes an eRx as well as integrated electronic ordering of labs and radiology studies. It also has built-in electronic faxing outbound, and integrated scanning of documents that makes scanning and adding documents or photos directly into patient charts very easy.
Practice Fusion now has their own integrated billing which I cannot comment on. However, they integrate with a number of billing softwares, one of which I do use, so codes from each visit are directly uploaded into our billing software. In the most recent upgrade, they added was instant checking of insurance eligibility with the ability to easily pull up patient benefits and co-payment information.
Howard E Friedman, DPM, Suffern, NY
08/28/2023
RESPONSES/COMMENTS (EMR) - PART 1 B
From: Jeffrey Kass, DPM, Navin Gupta, DPM
I currently use Sammy, Practice Fusion, and Criterions. Of the three, if I had to choose one - I like Practice Fusion the best. I don’t do any billing with Practice Fusion or Criterions, so I am really only comparing charting, e-prescribing, etc. I find Sammy has the most frustrating e-prescribing. I get kicked out of it on a daily basis. I wish they would drop their third-party e-prescriber or create a better interface as I have never had an issue e-prescribing in Practice Fusion.
Jeffrey Kass, DPM, Forest Hills, NY
I have used EMR/EHR and electronic claim transmission since 1992, yes 1992, at this point I'm on my 7th EMR. Having seen EMRs from infancy to today (still not matured). My latest, MODMED, is an all-in-one system. It's good on claims and on the financial side, but on the clinical side, the chatting is a MESS. The clinical side is like a grocery list with no logical flow. If you click on plantar fasciitis 10 times, it will add plantar fasciitis to your note 10 times. Answer: the grass is not much greener on the other side.
Navin Gupta, DPM, West Des Moines, IA
08/28/2023
RESPONSES/COMMENTS (EMR) - PART 1 A
From: Robert Dale, DPM, R. Alex Dellinger, DPM, Little Rock, AR
My current EMR is raising prices too. So, I am switching to an EMR called NextGen. It is a few hundred dollars less a month and is endorsed by the APMA.
Robert Dale, DPM, Clarksburg, WV
Our group, I am sure like many, was using a podiatry specific EHR going back to the days of the government's $44,000 "enticement". After recently being acquired, to use the new and improved product, we were quoted a price that was about 3x what we were paying before. What I didn't like about the new system was that the cost to use the system was based on gross collections. After researching other EMR systems, this seems to be the new way of doing things. What sense does that make? So we pay them based on a percent of collections? Seems like a money grab to me. We finally settled on Tebra (previously called Kareo). They still charge a set fee per provider. Quite frankly, they were the lesser of the evils -- but my billers like Tebra. They say billing, collecting, etc. is very good with this system.
R. Alex Dellinger, DPM, Little Rock, AR
08/24/2023
RESPONSES/COMMENTS (EMR)
From: Brian Kiel, DPM
I responded in PM News previously, but after seeing Dr. Purdy's letter, I felt that I had to respond. I do not think that EMR has been a joke. It has not taken away my concentration on a patient as I am not busy writing into a chart when talking with the patient. I can concentrate on the patient, I can look them in the face if I have to make a note, I keep a pad next me. Then I leave the room and immediately dictate into the chart through my EMR.
Yes, I do use some templates but they all have places to individualize them, and if the patient's condition varies from the norm, I just dictate as a fresh note. I see 35 to 40 patients a day, working from...
Editor's note: Dr. Kiel's extended-length letter can be read here.
08/23/2023
RESPONSES/COMMENTS (EMR) - PART 1 B
From: Jon Purdy, DPM
EMR has been a joke. There is no interoperability. It has taken away the concentration on patient care. The costs to a practice are far more than most realize. The obvious costs are those of the EMR system itself, and those are always rising. There is the cost of having to transition when these companies go out of business or are purchased by other companies. There are the costs of computers and IT to maintain them. There is a payroll cost to the added amount of time it takes employees to input data. And the biggest cost is a reduction in patient visits secondary to the time it takes to process them. There are other microeconomics at work as well.
The biggest joke is that “canned templates” were a big compliance problem in the past, but somehow they are perfectly acceptable...
Editor's note: Dr. Purdy's extended-length letter can be read here.
08/23/2023
RESPONSES/COMMENTS (EMR) - PART 1 A
From: Carl Solomon, DPM, Ivar E. Roth DPM, MPH
I also attended that EHR discussion in Dallas. Pete, do you remember the attorney's concluding comments? I vividly recall his words..."For the first time in my life, I'm not disappointed that I became a lawyer and not a doctor!"
Carl Solomon, DPM, Dallas, TX
It would be interesting to see what percentage of podiatrists are using EMR. I for one as a concierge podiatrist never found the need to use EMR in my practice, and I am very happy with my handwritten notes. The extra time goes into seeing the patient, not writing up a slew of notes that meet some criteria that has nothing to do with patient outcomes.
Ivar E. Roth DPM, MPH, Newport Beach, CA
08/22/2023
RESPONSES/COMMENTS (EMR)
From: Pete Harvey, DPM
Many years ago, I attended an EMR discussion in Dallas. This was during the time the government was offering incentives for EMR. The speaker was an attorney. At the end of his talk, he posed the question, “How much money do you think EMR (EHR) will cost you over the next few years?” Several of the audience posited anywhere from 10K-25K. My guess was over 100K and climbing. The attorney scoffed at this.
Turned out I was right. Hardware and software maintenance and continuing software updates are very expensive. However, in today’s medicine, EMR (EHR) is necessary to do business and effective record-keeping. There are many reasons for this, ranging from submission of electronic claims, effective communication with other healthcare professionals, compliance with the law, electronic Rx submission, and, of course, accurate medical records available at the push of a button.
Pete Harvey, DPM, Wichita Falls, TX
08/21/2023
RESPONSES/COMMENTS (EMR) - PART 1A
From: Eric Trattner, DPM, Brian Kiel, DPM
I couldn’t agree more!
Eric Trattner, DPM, Twinsburg, OH
In response to Dr. Sullivan's letter regarding EMR, try using the dictating part of the software. I use MModal Fluency Direct. I dictate directly into the chart. It is compliant with HIPAA and while you can’t go back and change a chart (which is good legally), you can add addendums to any record. The charges are entered as you finish the chart. That can be posted and sent to the appropriate carrier. Also, there are other dictating systems such as Dragon Speak.
Brian Kiel, DPM, Memphis, TN
08/21/2023
RESPONSES/COMMENTS (EMR) - PART 1 B
From: Elliot Udell, DPM
Our office switched to EMR many years ago. The trigger was that my own handwriting devolved to a point that I, myself, could not read it. EMR for me was a learning curve and even to this day, it takes a lot more time to do a note using an EMR program than to write it by hand or to dictate it. When my own GI doctor switched to EMR, he had to spend more time on the computer than with me.
The problem for this momentum toward EMR is to create a note that can easily be shared by other providers as well insurance companies and legal entities. The ideal, which has not been reached, is to somehow get all EMRs joined in some form of fashion so that if a patient comes to you from a doctor in Kalamazoo, you theoretically would be able press a few buttons and access all of the patient's notes, lab tests, and radiographic studies. This would cut costs because you would not need to repeat certain tests. Will we ever get there? Who knows? Bottom line, Dr. Sullivan: hang in there and eventually you will not want to go back to the days of handwritten notes.
Elliot Udell, DPM, Hicksville, NY
08/18/2023
RESPONSES/COMMENTS (EMR)
RE: Regrets About Switching to EMR
From: Tip Sullivan, DPM
After more than 30 years in practice, I allowed myself to become convinced that converting over to EMR (electronic medical records) was the thing to do. I believe that this has been the greatest challenge of my career. How I hated those stacks of paper charts on my desk every morning! Now, how I wish I had them back!
I am a simple-minded man and it seems to me that this could be done much easier. Think about it... the police wear cameras, sports people use Go Pro. I wonder why we can’t have a simple camera in the exam room or on our jacket to record the visit. Patient confidentiality could easily be handled with a consent. Billing could be done easily by the physician or a transcriptionist. We'd probably would have to get insurance companies on board—but mark my word - it is coming!
Tip Sullivan, DPM, Jackson, MS
07/18/2022
RESPONSES/COMMENTS (EMR)
From: Devin Poonai, DPM
I joined a private practice after finishing residency 7 years ago. So I am relatively young in age and experience. I do not use any EMR/EHR. For the first 6 months, I used a pen and paper templates. Then I created Microsoft Word templates and have been using them and printing notes and placing them in paper charts since. I take the MIPS/QIP, etc. hits from insurances, have cases of printer paper in the stock room, and have cabinets of paper charts. I could not be happier. My notes are not the canned, generated generic notes I get from so many other doctors/nurses.
“neck supple, trachea midline, no RRR, normal S1/S2, no bowel distension, AAOX3, sclera non-icteric, no jaundice, normo-cephalic, no Babinski sign.” Give me a break. I throw those notes out when they...
Editor's note: Dr. Poonai's extended-length letter can be read here.
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